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A client states, “My children still need me. Why did I get cancer? I am only 30.” This client is exhibiting which stage, according to Kübler-Ross?
Anger
Anger is the second stage and is exhibited by statement similar to “Why me?”
what is the difference between palliative and hospice care?
1- palliative care management and treatment of symptoms ex: pain, shortness of breath with focus on increasing quality of life and decreasing suffering palliative care can be provided with a long with interventions aimed at curing disease
2- Hospice Care symptoms management For Life limiting illness includes emotional support and bereavement Services for Families, can be provided at home or in a facility. Care is not focused on curing a disease
- Medicare requires less than 6 months prognosis - -- does not require DNR status
- patient can be discharged from hospice if they're prognosis improves
There are 2 types of advance directives?
1- Living wills- specific instructions on healthcare to be provided in specific situations.
2- Durable Power of Attorney for healthcare- person appointed as agent to make healthcare decisions in the event of incapacity.
What does full code mean?
when patient's heart stops beating or their breathing stops, You will do everything possible to bring the patient back to life do CPR
Full code means cure me
what is the difference between active and passive euthanasia?
1- Active euthanasia: is taking specific steps to cause patients death, doing something to end patient's life, and assisted suicide which is the clinician provides to the patient with the means to cause his or her own death for example giving a lethal prescription of barbiturates
2- passive euthanasia: withdrawing medical treatment with the intention of causing the patient's death, not doing something to preserve patient's life
A nurse is providing care to a terminally ill client. Which finding would alert the nurse to the fact that the client is dying? Select all that apply.
1- Pale, cool skin
2- Decreased urine output
3- Irregular heart rate
The children of a male client with late-stage Alzheimer disease have informed the nurse on the unit that their father possesses a living will. The nurse should recognize that this document is most likely to:
specify the treatment measures that the client wants and does not want.
When patient is about to die and they have only a minimum amount time, what is the most important intervention to implement as a nurse?
Ask the patient What does really matter to you?
what does DNR mean?
DNR or no code means patient wishes that there would be no attempts to resuscitate the patient when their breathing or heart stop functioning
As a nurse are you handing the medication to the patient to end their life?
no
The nurse is caring for a client who recently lost an older adult parent. Which client statement alerts the nurse that the stage of depression may have started within the grief process?
“Please go away; I just want to be left alone.”
The statement asking the nurse to go away and a desire to be “left alone” indicates withdrawal, which is a characteristic of depression.
A nurse is caring for a client whose spouse died more than 4 years ago. What assessment question will the nurse ask to determine if the client is experiencing abnormal grief?
“Have you gone through and donated your spouse’s clothing?”
What does POLST stand for?
Physician Order for Life Sustaining Treatment form medical order indicating patient whishes regarding treatment commonly used in medical crisis because it is medical order form must be completed and signed by Healthcare professional and cannot be filled out by a patient
What does DNI mean?
do not intubate the patient however patient can still get CPR and or oxygen
as a nurse what is your role when patient is identified to complete an autopsy procedure?
do not remove any lines or tubing from the patient
The nurse is trying to help the client cope with the dying process. Which nursing statement is most appropriate?
“It must be very difficult for you.”
Use statements with broad openings such as “It must be difficult for you” and “Do you want to talk about it?”
A client with end-stage chronic obstructive pulmonary disease (COPD) has reached the end of the 6-month period for hospice services and the family caregiver states, "I don't know what we will do if they cut off our hospice services." What is the best response by the hospice nurse?
"I will contact the health care provider to extend services since your family member meets the criteria."
what is POLST form and when is it used?
1- type of documentation? medical order
2- who completes it? Healthcare professional
3- who needs one? seriously ill or frail patients
4- appoints a surrogate? no
5- what is communication? specific medical order for treatment and whishes during medical emergency
6- can EMS use it? yes
Limited Code Orders
(if the patient has an IV medications, do the medication but do not do CPR)
how do you provide Postmortem Care
1.Wash the patient
2.Close their jaws
3.Close their eyes
4.Place identifiers
5.Put the patient in the bag (shroud
6.Tie patient hands and toe
7.Make sure the patient is in anatomical position
8.Ask the family member what they need, bring them chairs, water anything
9.Before the family says good bye (remove all the medical devices )
10.If they have dentures put them on
Assisted suicide is expressly prohibited under statutory or common law in the overwhelming majority of states. Yet public support for assisted suicide has resulted in a number of state ballot initiatives. The issue of assisted suicide is opposed by nursing and medical organizations as a violation of the ethical traditions of nursing and medicine. Which scenario would be an example of assisted suicide?
Administering a lethal dose of medication
Administering a morphine infusion may be used to assist with a client's pain near the end of life. Granting a client's request not to initiate enteral feeding when the client is unable to eat is an example of wishes of a terminally ill client, and the agreed-upon measures near the end of life.
The nurse is receiving a change of shift report on a client who has a terminal illness and has exhibited a slow and progressive decline in the health status over the past several days. Which data supports the client's impending death? Select all that apply.
1- Gurgling sounds emanating from the client's throat with each breath
2- Distended abdomen with last bowel movement documented 7 days ago
3- Cyanotic nail beds in hands and feet bilaterally
The Dying Person’s Bill of Rights
I have the right to be treated as a living human being until I die.
I have the right to maintain a sense of hopefulness, however changing its focus may be.
I have the right to be cared for by those who can maintain a sense of hopefulness, however changing this might be.
I have the right to express my feelings and emotions about my approaching death in my own way.
I have the right to participate in decisions concerning my care.
I have the right to expect continuing medical and nursing attention even though “cure” goals must be changed to “comfort” goals.
I have the right not to die alone.
I have the right to be free from pain.
I have the right to have my questions answered honestly.
I have the right not to be deceived.
I have the right to have help from and for my family in accepting my death.
I have the right to die in peace and dignity.
I have a right to retain my individuality and not be judged for my decisions, which may be contrary to beliefs of others.
I have the right to discuss and enlarge my religious and/or spiritual experiences, whatever these may mean to others.
I have the right to expect that the sanctity of the human body will be respected after death.
I have the right to be cared for by caring, sensitive, knowledgeable people who will attempt to understand my needs and will be able to gain some satisfaction in helping me face my death.
Terminal weaning
(remove patient from intubation)
Nursing diagnosis for loss, grief, and dying?
1- Impaired adjustment r/t newly diagnosed terminal illness
2- Impaired skin integrity r/t immobility
3- Impaired gas exchange r/t ventilation-perfusion imbalance
4- Anxiety r/t unpredictability of the course of illness
5- Nausea r/t effects of chemotherapy
6- Fatigue r/t constant demands of caring for dying husband